Long-Term Care Survey Alert

This simple formula can get a wound back on track.

If a wound stalls or deteriorates in its score on the PUSH tool, it usually does so for one of three reasons, which wound expert sometimes refer to as the "three-legged stool," according to Joyce Black, PhD, RN.

These reasons are as follows:

1. Support surface. The person may need better pressure-relief in the chair or bed or he may need to be constantly off the wound--for example, turning only onto the right or left side, says Black. "The patient can sit on the ulcer to eat, but he can only sit for one hour three times a day and on a pressure redistribution cushion."

2. Poor nutrition. This is a common reason for a wound to stall in healing, says Black. A good rule of thumb: Whatever the resident ate before he developed the wound won't be enough to promote optimal healing, she notes. So refer the resident for a dietary consult to see if he needs more calories and protein.

3. Infection. Assess the wound for exudate (drainage), erythema (redness) and odor. If you suspect infection, get the physician involved immediately. Black has seen wounds go from healing to stalled on the PUSH assessment tool over a two-week period where the resident has clear signs of infection, wound pain and a fever. "And no one has [changed the plan of care]. People can get septic and die from an infected pressure ulcer," she warns.